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Organization
ROYAL BLUE MEDICAL CENTER GA. INC
Active
Organization
ROYAL BLUE MEDICAL CENTER GA. INC
Active
Other names
Royal Blue Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OMAR ELLISON (OWNER)
(704) 277-1750
Entity
Organization
Contact information
Practice address
555 OLD NORCROSS RD STE 100, LAWRENCEVILLE, GA 30046-8703
(704) 277-1750
Mailing address
2023 CONNONADE DR, WAXHAW, NC 28173-0109
(704) 277-1750
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
NULL
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
2083S0010X
Sports Medicine (Preventive Medicine) Physician
—
NULL
2083S0010X
Sports Medicine (Preventive Medicine) Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
261QP3300X
Pain Clinic/Center
—
NULL
Other
Enumeration date
11/08/2019
Last updated
09/08/2020
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